INTRO: thermal, mechanical, EMG agents purpose
thermal: transfer energy by inc/dec tempmechanical: apply force to inc/dec pressureEMG: apply energy by electrical current or radiation
INTRO: Thermal Agentsdiathermy - what and for what
shortwave EMG for deep tissues with high conductivity
INTRO: Thermal Agentsultrasound - how many frequency, thermal vs. non (by/for)
20k cycles/soundthermal: by continuous wavesnonthermal: continuous and pulsed waves; for tissue healing and transdermal drug penetration
INTRO: Thermal Agentsthermo vs. cryotherapy: muscle spasm, pain, joint stiffness, circulation, metabolic, enzymatic rate, tissue extensibility, oxygen-hemoglobin dissociation
both dec: spasm and paincryo: decthermo: inc
INTRO: 4 methods for heat energy transfer (3.2.1.2) + direct piezoelectric effect
conduction: HMP, PWB, cold packsconvection: cold whirlpool, fluidotherapyevap: vapocoolantconversion: IR, ultrasound, diathermydirect piezoelectric effect: mechanical to electrical
INTRO: Mechanical Agentshydro, traction, comp - for (4.2.1), inc or dec pressure
hydrotherapy- buoyancy, resistance, hydrostatic pressure, pressure to clean wounds- immersed or not- immersed: inc buoyancy, pressure, transfer heattraction- alleviates pressure- to normalize sensation, control inflammation compression- inc pressure, counteract fluid pressure- control edema
INTRO: EMG Agents3 levels, wavelength x frequency relationship
- 7.5 x 10^14-15: erythema and tanning, no heat- 10^11-14: superficial heat- 10^5-6: deep heatshorter wavelength = higher frequency
INTRO: EMG Agentsnon-thermal SWT - what agent, energy/heat, 3 purposeES - 2 types, purpose (2.3), EMG biofeedback
nSWT- pulsed diathermy- emits low energy = no heat- control edema and pain, cell membrane permeability and functionES- motor-level ES (induce contraction), sensory-ES: change sensation- with sufficient intensity and duration: control pain and muscular strength- with appropriate direction: edema, tissue healing, transdermal drug penetration- EMG biofeedback: contractions detected by nodes fed back to pt to initiate/inhibit contraction
INTRO: Effects of Agents - Inflammationthermal vs. mechanical vs. EMG purpose (2.2.1)
thermal: circulation and chemical reactionsmechanical: motion and fluid flowEMG: cell function and transport
INTRO: Effects of Agents - Inflammationinflam phase - how long, what phase, what happens, agents effect (3), agent for cleaning (1), good (3), don't (2) + why
- 1-6 days; immobilize and support phase- cells remove debris and prevent bleeding- agents effect: control motion, dec circulation and enzyme activity- clean: non-immersion hydrotherapy- good: ES, SWT, cryo- don't: thermo and motor-level ES (vasodilates = inflammation)
INTRO: Effects of Agents - Inflammationinflam phase acute inflam - goal (3), 5 agents, contraindication
- goal: control bleeding, pain, edema- cryo, SWT, sensory-ES, compression, contrast bath- if high-dosed catabolic corticosteroids = inhibit inflam = delayed healing = no cryo
INTRO: Effects of Agents - Inflammationinflam phase chronic inflam - 3 goals, don't and why
- goal: inc circulation, dec joint stiffness, control pain- no cryo bc inc stiffness
INTRO: Effects of Agents - Inflammationinflam phase chronic inflam - agents (4.3.6)
- stiffness: thermo, fluido, whirlpool, ES- pain: thermo, fluido, ES, laser- circulation: thermo, ES, compression, SWT, water immersion, motion
INTRO: Effects of Agents - Inflammationproliferation - how long, 3 main ganap, 3 agent effect, 3 goals
- 3-20 days post-injury- collagen is deposited to replace tissue, myofibroblasts contract to hasten closure, epithelial cells migrate to resurface wound- agents effect: inc circulation and enzyme, promote collagen deposition- goals: control scar tissue formation, circulation, strength and flexibility
INTRO: Effects of Agents - Inflammationproliferation - 1 agent with 3 purpose, agents (6.1)
- static compression: against scar, contracture, promote cosmesis- circulation: thermo, ES, compression, water immersion, motion, contrast baths- flex: thermo
INTRO: Effects of Agents - Inflammationmaturation - how long, 2 main ganap, 2 agent effect, 1 goal
- 9 days to 2 years post-injury- deposition and resorption of collagen, tissue remodeling- agents effect: alter balance of collagen depo and resorp, align new fibers- goal: earlier effects
INTRO: Effects of Agents - Inflammationmaturation - agents (2.1.1)
- regain strength: motor ES, water motion- flexibility: thermo- scar: compression
INTRO: Effects of Agents - Pain 3 agents effect, CRPS is what and 4 agents
- agents effect: modify transmission, perception, underlying process causing sensationcomplex regional pain syndrome- due to overactivation of SNS- mild cool, neutral warmth, gentle fluidotherapy, water immersion
INTRO: Effects of Agents - Pain acute pain - agents (2.1.3) + to reactivate
- to reactivate: water therapy- control pain: cryo, sensory-ES- control inflam: cryo- prevent aggravation: immobilization, low-load static traction
INTRO: Effects of Agents - Pain chronic pain - 4 goals, 3 agents in one of those goals, what not to do, how to do one more goal
- goal: coping, restore function, underlying pathology, enhance strength- in deconditioned pt: water exercise, motor-ES, EMG biofeedback- no bedrest- improve coping by letting pt do it
INTRO: Effects of Agents - Pain referred pain - what pathology, agents (3.1)
radicular pain caused by spinal nerve root dysfunction- pain: thermo, cryo, ES- inflammation: spinal traction
INTRO: Effects of Agents - Pain malignancy pain - what not agents (2), agents (3)
no: ultrasound, diathermyyes: ES, cryo, superficial thermo
INTRO: Effects of Agents - Motion Restrictionagents when source is muscle weakness-strength (3), rest and motion (6), motion (4), soft tissue shorten (1), bony block (2)large (3) small (3) agents
- muscle weakness to strength: EMG bio, water exercise, motor-level ES- at rest and with motion: ES, cryo, thermo, SWT, EMG bio, spinal traction- with motion only: ES, cryo, thermo, SWT- soft tissue shortening to lengthen: thermo- bony block to compensate: thermo or brief ice- large: motor, diathermy, IR- small: paraffin, whirlpool, ultrasound
INTRO: Effects of Agents - Muscle Tonewhat, 3 agent effect, hyper (2.3) hypo (3) fluctuating (1)
- underlying tension for muscle contraction - agent effect: alter nerve conduction, sensitivity, biomechanical properties of muscle, indirect reduce pain- hypertonicity: motor-ES or quick icing on antagonists; neutral warmth, prolonged cryo, EMG bio- hypotonicity: motor-ES, EMG bio, quick icing on agonist- fluctuating: functional ES (elicit contraction at time)
INTRO: A-delta vs. C fiberssize, myelin, AP transmission velocity, pain, pain localization
a-delta- unipolar from DRG, small, myelinated, 30, localized- sharp, pricklingc fibers- unipolar from DRG, smallest, unmyelinated, 2, diffusely localized- dull, throbbing, aching
CRYO: Effects - Hemodynamic initial dec in flow - vaso what and how long, stimulates and therefore also what, reduces what mediators (2) and therefore increases what neurons, increases what in blood quality and thereforelater dec - CIVD what, hunting response mediated by what due to what, where in body
initial decrease in blood flow- vasoconstricts for 15-20 mins- stimulate smooth muscle = stimulate thermoreceptors- reduce vasodilator mediators (histamine and prostaglandins) = reduce vasodilation = more sympathetic adrenergic neurons = vasoconstrict- increase blood viscosity/restriction = less blood flow that could warm arealater decrease- cold-induced vasodilation: when prolonged application/less than 10C- hunting response: mediated by axon reflex due to pain or prolonged cold- more likely in distal
CRYO: Effects - Neuromuscularnerve conduction velocity - inc or dec, how long (start and end), higher effect on what fiber, reversible block how
- decrease- within 5 minutes but return by 15 mins- higher effect on myelinated small (A-delta)reversible total nerve conduction block: by superficially putting ice on major nerve branches (peroneal)
CRYO: Effects - Neuromuscular pain/threshold - inc or dec, two hows
- decreased- by gate control mechanism = block pain stimuli = block pain-spasm-pain cycle- by reducing flow = no acute inflammation/edema = no pain
CRYO: Effects - Neuromuscular muscle strength - how long (start and end), why end (4), therefore don't whatspasticity - how long effect, what is reduced and therefore reduces (2) and reduces (2)facilitation of contraction - quick apply vs. longer
- isometric inc at 5 then dec at 20 mins- dec bc: inc joint stiffness, dec circulation, inc blood viscosity, slowed conduction- dont cool down 20 mins+spasticity- reduced gamma motor neuron activity = reduced discharge from afferent and GTO (inhibitory) = reduced stiffness and resistance to PROM- 1 to 1.5hrsfacilitation of contraction- quick apply: inc alpha motor neuron = contract muscle- if longer apply: reduced gamma motor activity = reduced forceif quick cool only u inc alpha (strength) which is why isomet strength inc within 5 mins, but if longer then what you reduce na is gamma and GTO (inhibitory) and less inhibit just means you're free to reach ROM but no more extra strength from alpha which is why isomet strength is only until 20 mins. by 20, range nalang meron ka
CRYO: Effects - Metabolicinc or dec rate and therefore, inhibits activity of what in OA and RA
- dec reactions of inflammation and healing- inhibits catabolic-degrading enzymes in OA and histamine in RA
CRYO: Indicationsinflammation - how long use and interval, how (2), pathology
- how: 15 mins, 1h interval- slower metabolic = reduce heat, edema, red, loss of function- vasoconstrict + inc viscosity + dec capillary permeability = reduce bleeding and fluid loss- reduce severity of DOMS (from inflam)
CRYO: Indicationsedema control - reduce what substance and therefore, vaso what inc/dec what, how to do
- vasoconstrict = dec intravascular pressure- reduce vasoactive substance (histamine) = control permeability ASAP with elevation
CRYO: Indicationspain control - how long for how long
15 mins, 1h
CRYO: Contraindicationscold-induced urticaria (presentation), cryoglobulinemia (aggregation of what forms what and therefore), paroxysmal cold hemoglobinuria (what is released where), raynaud (what, 2 presentation)
cold-induced urticaria: severe pain, numbness, skin color changecryoglobulinemia: aggregation of serum proteins = forms gel/precipitate = dec circulation = ischemiaparoxysmal cold hemoglobinuria: hemoglobin into urineraynaud: idiopathic paroxysmal; sudden cyanosis and pallor; bilat and symmetrical if disease
CRYO: Application Techniquessequence of symptoms
cold burn ache numbnessonly until cold if quick icing
CRYO: Application Techniquescold or ice packs - made of/ease/aggressiveness, temp (use), time (cooling and for interval), usage (interval)
- cold pack: gelatin or saline or silica; easier but expensive- ice pack: more aggressive so more insulation- temp: semisolid at 0-5C- time: cool for 2h, 30 mins between uses- usage: every 1-2h
CRYO: Application Techniquesquick/brief icing - for, usage
- for: CNS disorder- usage: 3-5x
CRYO: Application Techniqueschemical cold packs - for, temp (cooling), time (cooling and for interval), usage (duration)
- for emergencies- temp: -12C- time: cool for 24h, 30 mins between uses- usage: 10-15 mins
CRYO: Application Techniquesice towels - usage (duration and interval)
- usage: 10-15 mins, 4-5 mins replace
CRYO: Application Techniquescold baths - for, temp (cooling)
- for distal extremities- temp: 13-18C
CRYO: Application Techniquesice massage - usage (duration)
time: 5-10 mins or until analgesia
CRYO: Application Techniquescontrolled cold compression unit - for, usage (duration and interval)
- for: swelling, edema, inflam, pain, blood loss, ROM- usage: continuous or intermittent, 15 mins every 2h
CRYO: Application Techniquesvapocoolant - 2 unused chemicals 2 common, usage (duration distance angle)
- ethyl chlorine: flammable and volatile, has anesthetic effects when inhaled, excessive temp drop- fluori methane: nonflammable but volatile, damage ozone- pentafluoropropane and tetrafluoroethane- usage: 2-5x, 30-46cm away 30 deg
CRYO: Application Techniquescold whirlpool - for, temp (actual), usage (duration)
- for cryo + motion- temp: 10-16C- usage: 5-15 mins
THERMO: Effects - Hemodynamicvaso what - mediated by what, production of what primary mediator, what happens to smooth muscles, inflam increases production of what (2)thermoreceptors go where then synapse with neurons where and therefore decrease what and therefore dec what activity and therefore what happens to muscle
vasodilation- mediated by axon reflex- production of nitrous oxide (primary mediator)- relax smooth muscles = vasodilate- inc temp = inflam = inc vasodilator (histamine and prostaglandin) = vasodilatedistant vasodilative effect- cutaneous thermoreceptors going via DRG = synapse with neurons in lateral gray horn = dec sympathetic adrenergic neuron = dec sympathetic activity = dec muscle contraction = vasodilateby: direct reflex activation of smooth muscles by thermoreceptors, indirect activation of spine reflex, local release of inflam mediators
THERMO: Effects - Neuromuscularnerve conduction velocity and firing rate - inc or dec + ratio, for (2), caution with what pathology (2 examples and why)inc/dec firing rate of what type fiber from where = inc/dec firing rate of and therefore [5 events]
- inc velocity ( 2m/s:1C), dec conduction latency/firing rate- for reduced pain perception, improve circulationdemyelinated nerves- carpal tunnel, multiple sclerosis- faster Na channel opening = less depolarize = nerve conduction- be cautious- inc firing rate of type Ib from GTO = reduce firing rate of alpha motor neuron (strength/contract) = reduce gamma neuron activity (force/contract) = reduce muscle spindle stretch = reduce muscle spasm = relax muscle
THERMO: Effects - Neuromuscularmuscle strength and endurance - two timeframes (inc/dec 3 = inc/dec firing rate of what = what happens to strength)(what happens to strength)
first 30 mins: - inc firing rate of type II spindle efferent, gamma efferent, type IB fibers = dec firing rate of alpha motor neurons = dec strength30 mins to 2h:- strength gradually recovers until higher than pretreatment
THERMO: Effects - Neuromuscularpain threshold - inc/dec, primary mechanism = dec what = inc what = therefore final two effects
increasedgating against sensation = dec ischemia = inc blood flow = no spasm = reduce pain
THERMO: Effects - Metabolicmetabolic and enzymatic rate - inc/dec from what temp until what temp, inc/dec what (4) and therefore, also inc/dec what and therefore
- inc up to 45C then cease by 50C- inc oxygen uptake and nutrients and remove waste and dissociation of oxygen from hemoglobin = accelerate healing- also inc rate of destructive (like RA) so avoid areas of inflam
THERMO: Effects - Collagen Extensibilitywhat occurs, best in what temp range and time
plastic deformation = more elastic40-45C for 5-10 mins
THERMO: Contraindicationswhy hemo and thrombo
- hemorrhage: vasodilation reopens vascular lesion- thrombo: blood clot
THERMO: Precautionswhy metal and demyelinated nerve + which 3 agents
metal: higher conductivity and specific heat demyelinated: conduction block; fluido, heat lamp, water bath
THERMO: Adverse effectsburn - two events at what temp each, therefore use whatfainting - why
- burn: protein denaturation at 45C and cell death at 43C; use agents that cool- fainting: inadequate cerebral blood
THERMO: Application techniqueswhich has higher specific heat and conductivity in superficial and thereforewhich pt can take home
HMP > fluido and PWBhotter and fasterHMP and PWB
THERMO: Application techniques HMP - made of what, temp (prepare), time (prepare interval usage), chemical vs. electrical (for and time effect)
- made of bentonite, hyrophilic silicate gel + canvas- temp: 70-75C (prepare)- time: 2h (prepare) 30 mins (interval) 15-20 (usage) - chemical: for LBP and wrist pain stiff flexibility; effect for 1-8h- electrical: not used bc does not cool
THERMO: Application techniques PWB - made of and ratio, temp (actual prepare), time (usage), dips
- paraffin wax and mineral oil (6/7:1)- temp: 54 to 45-50C (actual), 52-57C (prepare)- time: 10-15 mins (usage) or 6-10 dips
THERMO: Application techniques fluido - made of, exclusive to, heating pattern, temp (actual), time (usage)
- ground cellulose from corn- exclusive to extremities- circular heating pattern- temp: 38-48C (actual)- time: 20 mins (usage)
THERMO: Application techniques IRR - watts, velocity, depth, radiation relationship with distance and angle of incidence, distance (2), time (prepare usage)
- IR-A: 770-1400, 50-1500 watts, 3x10^8 velocity, 1-3mm- radiation IVP distance (square), DP angle of incidence- time: 5-10 mins (prepare), 10-15 mins (usage)- distance: 40-45 (luminous), 74-91 (non)
THERMO: Application techniques contrast bath - what, for (5), temp (actual), time + number of times
- alternate hot and cold, vasodilate and vasoconstrict- for: chronic edema, subacute trauma, hyperalgesia or hypersensitivity from dystrophy, inflammation (sprain strain tendonitis)- temp: 38-44C and 10-18C (actual)- time: 3-10 mins warm 1-3 mins cold, 5-6x